Healthcare Provider Details

I. General information

NPI: 1215691928
Provider Name (Legal Business Name): AUDIOLOGY CENTER OF NORTHERN COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST STE H102
FORT COLLINS CO
80526-1727
US

IV. Provider business mailing address

2001 S SHIELDS ST STE H102
FORT COLLINS CO
80526-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-893-7621
  • Fax: 970-893-7622
Mailing address:
  • Phone: 970-893-7621
  • Fax: 970-893-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: G. NATALIE PHILLIPS
Title or Position: OWNER
Credential: AU.D.
Phone: 970-988-6037